Vibration-controlled transient elastography

Tapper, Elliot B.; Afdhal, Nezam H.

doi:10.1097/mog.0000000000000169

Cited by 19 publications

(10 citation statements)

References 53 publications

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“…This might have been the reason why significant fibrosis (defined as LSM≥7 kPa) and even cirrhosis (LSM≥10.3 kPa) were observed with a prevalence of 16.7-18.8% and 13.8%, respectively, as reported by the authors who used transient elastography and CAP to assess liver steatosis and fibrosis [36, 37]. It should be also noticed that LSM cut-off values for significant fibrosis and cirrhosis as measured by TE are not the same for different etiologies of liver diseases [38]. By using FIB4, a representative of biochemical tests, the prevalence of advanced fibrosis (F≥3) in our cohort was “only” 3.8%.…”

Section: Discussionmentioning

confidence: 97%

Ultrasound Grade of Liver Steatosis Is Independently Associated with the Risk of Metabolic Syndrome

Mustapić

Ziga

Matić

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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The aim of the study was to explore (a) prevalence and grade of nonalcoholic fatty liver (NAFL) among outpatients referred for abdominal ultrasound (US) examination and (b) relationship between the presence and severity of liver steatosis and metabolic syndrome (MS). This was a retrospective analysis of patients without history of liver disease examined by abdominal US in the University hospital setting. US was used to detect and semiquantitatively grade (0-3) liver steatosis. Data on patients' age, gender, body mass index (BMI), impaired glucose metabolism (IGM), atherogenic dyslipidaemia (AD), raised blood pressure (RBP), transaminases, and platelet counts were obtained from medical records. MS was defined as having at least 3 of the following components: obesity, IGM, AD, and RBP. Of the 631 patients (median age 60 years, median BMI 27.4 kg/m2, and 57.4% females) 71.5% were overweight and 48.5% had NAFL. In the subgroup of 159 patients with available data on the components of MS, patients with higher US grade of steatosis had significantly higher BMI and increased prevalence of obesity, IGM, AD, RBP, and accordingly more frequently had MS, whereas they did not differ in terms of age and gender. NAFL was independently associated with the risk of having MS in a multivariate model adjusted for age, gender, BMI, and IGM. The grade of liver steatosis did not correlate with the presence of liver fibrosis. We demonstrated worrisome prevalence of obesity and NAFL in the outpatient population from our geographic region. NAFL is independently associated with the risk of having MS implying worse prognosis.

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Section: Discussionmentioning

confidence: 97%

Ultrasound Grade of Liver Steatosis Is Independently Associated with the Risk of Metabolic Syndrome

Mustapić

Ziga

Matić

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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“…(9, 16) This velocity is converted mathematically into a liver stiffness measurement (LSM) which is depicted in kiloPascals (kPa). A successful VCTE exam was defined by the acquisition of 10 successful measurements where the interquartile range of the LSM does not exceed 30% of the median LSM.…”

Section: Methodsmentioning

confidence: 99%

The Performance of Vibration Controlled Transient Elastography in a US Cohort of Patients With Nonalcoholic Fatty Liver Disease

Tapper

Challies

Nasser

et al. 2016

American Journal of Gastroenterology

138

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Background Identification of patients with Nonalcoholic Fatty Liver Disease (NAFLD) who have advanced fibrosis is crucial. Vibration Controlled Elastography (VCTE) is an alternative to biopsy; though published experience with VCTE in a U.S. population is limited. Methods We performed a prospective cohort of 164 biopsy-proven NAFLD patients evaluated with VCTE using an M probe and NAFLD Fibrosis Score (NFS) at baseline and a repeat VCTE at 6 months. Reliable liver stiffness measurements (LSM) were defined as 10 valid measurements and interquartile range (IQR) < 30% of the median. Results 120 (73.2%) patients had reliable LSM. The median LSM for patients with and without F3–F4 (advanced) fibrosis were 6.6 kPA (5.3 – 8.9) and 14.4 kPA (12.1 – 24.3), respectively. The optimal LSM cutoff for advanced fibrosis was 9.9 kPa (sensitivity 95%, specificity 77%). Additionally, 100% of patients with LSM < 7.9 kPa did not have advanced fibrosis. A risk stratification strategy based on VCTE avoids the need for biopsy in at least the 74 (45.1%) patients correctly classified as low risk for advanced fibrosis. The area under the receiver operating curve (AUROC) of 0.93 (95% CI: 0.86–0.96). For the detection of F3-F4 fibrosis in patients with reliable VCTE, the AUROC of VCTE is superior to that of NFS (0.77), p=0.01. Patients who achieved a ≥5% weight loss at 6 month follow-up experienced improved LSM (p = 0.009), independent of changes in aminotransferase levels. Conclusion Reliable VCTE results can rule out advanced fibrosis and avoid the need for biopsy in at least 45% of US patients with NAFLD. However, 1 in 4 patients have uninterpretable studies using the M probe.

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“…Over the last decade non-invasive methods have increasingly replaced liver biopsy (LB) for the purpose of determination of the stage of liver fibrosis (LF) ( 1 ). Among different diagnostic approaches, ultrasound (US) based transient elastography (TE) has been widely accepted by the hepatologists due to its simplicity and reliability, with a huge amount of data to support its use in different etiologies of liver diseases ( 2 ). On the other hand, TE has limitations due to the fact that it does not allow two-dimensional (2D) imaging of the investigated structures, cannot be applied in patients with ascites, and investigation of the spleen can be performed only when proper spot has been chosen by conventional ultrasound.…”

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confidence: 99%

Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis

et al. 2015

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AimPrimary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV).MethodsPredictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV.ResultsIn the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients.ConclusionThis is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients.

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Vibration-controlled transient elastography

Abstract: When combined with serologic markers of fibrosis, VCTE allows the vast majority of patients to avoid a liver biopsy.

Cited by 19 publications

References 53 publications

Ultrasound Grade of Liver Steatosis Is Independently Associated with the Risk of Metabolic Syndrome

Ultrasound Grade of Liver Steatosis Is Independently Associated with the Risk of Metabolic Syndrome

The Performance of Vibration Controlled Transient Elastography in a US Cohort of Patients With Nonalcoholic Fatty Liver Disease

Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis

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